Clinical Results of Auto-Iliac Cancellous Bone Grafts Combined with Implantation of Autologous Bone Marrow Cells for Osteonecrosis of the Femoral Head: A Minimum 5-Year Follow-Up
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Purpose: There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH. Materials and Methods: Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis. Results:At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results. Conclusion: The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions,this procedure generated clinical results comparable to those of other head preserving procedures.
Abstract
Purpose: There are no reports about bone graft and cell therapy for the osteonecrosis of femoral head (ONFH). We prospectively evaluated the clinical results of auto-iliac cancellous bone grafts combined with implantation of autologous bone marrow cells for ONFH. Materials and Methods: Sixty-one hips in 52 patients with ONFH treated with bone graft and cell therapy were enrolled, and the average follow-up of the patients was 68 (60-88) months. Necrotic lesions were classified according to their size by the Steinberg method and location of necrosis. Results:At the last follow-up, the percentage of excellent or good results was 80% (12/15 hips) in the small lesion group, 65% (17/26 hips) in the medium size group, and 28% (6/20 hips) in the large size group. The procedures were a clinical success in 4 of 5 hips (80%) of stage I, 23 of 35 hips (65.7%) of stage II, 7 of 18 hips (38.9%) of stage III, and 1 of 3 hips (33.3%) of stage IV grade, according to the Association Research Circulation Osseous grading system. Among the 20 cases with large sized necrotic lesions, 17 cases were laterally located and this group showed the worst outcomes, with 13 hips (76.5%) having bad or failed clinical results. Conclusion: The results of the present study suggested that patients who have a large sized lesion or medium sized laterally located lesion would not be good candidates for the head preserving procedure. However, for medium sized lesions,this procedure generated clinical results comparable to those of other head preserving procedures.
참고문헌 (26)
- Meyers MH, "Osteonecrosis of the femoral head. Pathogenesis and long-term results of treatment", Clin Orthop Relat Res, 1988, pp.51~61 (1988)
- Mont MA, "Non-traumatic avascular necrosis of the femoral head", J Bone Joint Surg Am, 77, pp.459~474 (1995)
- Hungerford DS, "The Role of Core Decompression in the Treatment of Osteonecrosis of the Femoral Head, In Osteonecrosis: etiology, diagnosis and treatment", pp.287~292 (1997), American Academy of Orthopaedic Surgeons
- Katz RL, "Total hip arthroplasty in patients with avascular necrosis of the hip. Follow-up observations on cementless and cemented operations", Clin Orthop Relat Res, (281), pp.145~151 (1992)
- Mont MA, "Core decompression and nonvascularized bone grafting for the treatment of early stage osteonecrosis of the femoral head", Instr Course Lect, 56, pp.213~220 (2007)
- Mont MA, "Understanding and treating osteonecrosis of the femoral head", Instr Course Lect, 49, pp.169~185 (2000)
- Steinberg ME, "Does lesion size affect the outcome in avascular necrosis?", Clin Orthop Relat Res, 1999, pp.262~271 (1999)
- Camp JF, "Core decompression of the femoral head for osteonecrosis", J Bone Joint Surg Am, 68, pp.1313~1319 (1986)
- Koo KH, "Preventing collapse in early osteonecrosis of the femoral head. A randomised clinical trial of core decompression", J Bone Joint Surg Br, 77, pp.870~874 (1995)
- Marcus ND, "The silent hip in idiopathic aseptic necrosis. Treatment by bone-grafting", J Bone Joint Surg Am, 55, pp.1351~1366 (1973)
- Mont MA, "The trapdoor procedure using autogenous cortical and cancellous bone grafts for osteonecrosis of the femoral head", J Bone Joint Surg Br, 80, pp.56~62 (1998)
- Stulberg BN, "Osteonecrosis of the femoral head. A prospective randomized treatment protocol", Clin Orthop Relat Res, (268), pp.140~151 (1991)
- Steinberg ME, "Core decompression with bone grafting for osteonecrosis of the femoral head", Clin Orthop Relat Res, (386), pp.71~78 (2001)
- Gangji V, "Treatment of osteonecrosis of the femoral head with implantation of autologous bone-marrow cells. A pilot study", J Bone Joint Surg Am, 86-A, pp.1153~1160 (2004)
- Gangji V, "Abnormalities in the replicative capacity of osteoblastic cells in the proximal femur of patients with osteonecrosis of the femoral head", J Rheumatol, 30, pp.348~351 (2003)
- Hernigou P, "Treatment of osteonecrosis with autologous bone marrow grafting", Clin Orthop Relat Res, 2002, pp.14~23 (2002)
- Hernigou P, "Abnormalities in the bone marrow of the iliac crest in patients who have osteonecrosis secondary to corticosteroid therapy or alcohol abuse", J Bone Joint Surg Am, 79, pp.1047~1053 (1997)
- Hernigou P, "Decrease in the mesenchymal stem-cell pool in the proximal femur in corticosteroid-induced osteonecrosis", J Bone Joint Surg Br, 81, pp.349~355 (1999)
- Yoshioka T, "Concentrated autologous bone marrow aspirate transplantation treatment for corticosteroid-induced osteonecrosis of the femoral head in systemic lupus erythematosus", Int Orthop, 35, pp.823~829 (2011)
- Steinberg ME, "A quantitative system for staging avascular necrosis", J Bone Joint Surg Br, 77, pp.34~41 (1995)
- Nam KW, "Fate of untreated asymptomatic osteonecrosis of the femoral head", J Bone Joint Surg Am, 90, pp.477~484 (2008)
- Ficat RP, "Idiopathic bone necrosis of the femoral head. Early diagnosis and treatment", J Bone Joint Surg Br, 67, pp.3~9 (1985)
- Hungerford DS, "Pathogenesis of ischemic necrosis of the femoral head", In the hip proceeding of the eleventh open scientific meeting of the Hip Society, pp.219~262 (1983), CV Mosby
- Launder WJ, "Hemodynamics of the femoral head", J Bone Joint Surg Am, 63, pp.442~448 (1981)
- Merle D’Aubigné R, "Idiopathic necrosis of the femoral head in adults", J Bone Joint Surg Br, 47, pp.612~633 (1965)
- Mont MA, "Non-traumatic avascular necrosis of the femoral head", J Bone Joint Surg Am, 77, pp.459~474 (1995)